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WAL-MART PHARMACY 10-5315
CAH341327-00 J ARTHUR DOSHER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
J ARTHUR DOSHER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH341327-00
Entity Address
924 N HOWE ST
SOUTHPORT, NC 28461
Medicare Provider Number
341327
Participating Start Date
7/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/2/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brandon Hughes, Director of Finance
(910) 454-4728
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/2/2020
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